Hi,
i'm a 24 year old male. I have had an accident falling from the a wall around three meters high and it was four and a half months ago (04/06/07 to be exact). Initially I was diagnosed with distortion of talocrural joint (2nd degree). But as the pain in my ankle did not get any better over time and in fact it increased. My first orthopedist sent me to do a CT of the TC joint. That CT showed an unhealed fracture of the medial portion of the talus. After that I've been to two other doctors who sent me to ask for second opinion because they were, as they said, more of a knee specialist. A few days ago I did a MS-CT which showed the same big fragment and also a few other smaller ones (up to 0,5 cm).
Pain in the ankle is bearable but quite uncomfortable when I'm not active, but during any activity that includes standing and walking it gets more paintful.
Also I experience some pain flexing my big toe, which is probably due to the fact that the fracture goes through sulcus of the FHL muscle tendon.

My question is what is your opinion the treatment should be. It's been more than four months since the accident. And the fragment clearly isn't going to heal on it's own. Is surgery the best way to go, actually is there an alternative? If so, is the fragment suitable for arthroscopic surgery or open surgery would be required? And what are long term consequences of the procedure or if some other less invasive method would relieve the pain? Also I would like to know is there a techinque of reattaching the fragment after such a long time?

In the attachment you'll find transverse and coronal section of the MS-CT scan. Upon request I can deliver all the images from the scan.

Unfortunately this really is a pretty specialized question that an orthopedic surgeon should answer. Currently, we do not have an orthopedic surgeon on our editorial board.

Just based on my knowledge of orthopedics I suspect that this probably needs to be surgically repaired, although I can't be sure. I am unable to comment regarding laparoscopic vs. open surgical correction.